<%@ page language="java" contentType="text/html; charset=UTF-8" pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<%@ taglib prefix="fmt" uri="http://java.sun.com/jsp/jstl/fmt"%>
<!DOCTYPE html>
<html lang="zh-CN">
  
  <head>
    
    <%@ include file="/WEB-INF/include/meta.jsp"%>
    <%@ include file="/WEB-INF/include/css.jsp"%>
    
  </head>
  <!-- end header -->
  <body>
    <div class="page-group">
      <div class="page page-current">
        
        <header class="bar bar-nav">
          <h1 class="title pull-left" style="width: 45%; font-size: 1.2rem; color: #F36767;">支付成功!</h1>
          <p class="pull-right" style="width: 55%; font-size: .6rem; line-height: .8rem; margin: .3rem 0;">客服会在1个工作日内联系您！稍安勿躁~</p>
        </header>
        
        <div class="content student-investigation" style="top: 3rem;">
          <h3 class="text-center" style="background-color: #FFFAE1; margin: 0px; line-height: 2rem;">注意</h3>
          <p class="text-center" style="font-size: .7rem; font-weight: bold; padding: 0 2rem;">为了有助于教练了解您个人信息，请您花费1分钟填写以下信息：</p>
          
          <form action="${ctx.host}/shop/investigation" method="POST">
            
            <input type="hidden" name="orderId" value="${order.id}">
            
            <div class="list-block">
              <a href="javascript:void(0);" class=".upload-image">upload</a>
            </div>
            
            <div class="list-block">
              <ul>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">身高(cm)：</div>
                    <div class="item-input">
                      <input type="text" name="height" placeholder="请输入身高(cm)">
                    </div>
                  </div>
                </li>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">体重(kg)：</div>
                    <div class="item-input">
                      <input type="text" name="weight" placeholder="请输入体重(kg)">
                    </div>
                  </div>
                </li>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">年龄(岁)：</div>
                    <div class="item-input">
                      <input type="text" name="age" placeholder="请输入年龄(岁)">
                    </div>
                  </div>
                </li>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">微信或手机：</div>
                    <div class="item-input">
                      <input type="text" name="wechatNumber" placeholder="请输入微信号或手机号">
                    </div>
                  </div>
                </li>
                <li class="item-content item-link">
                  <div class="item-inner">
                    <div class="item-title">性别：</div>
                    <div class="item-input">
                      <input type="text" name="sexSelector" placeholder="请选择性别">
                      <input type="hidden" name="sex">
                    </div>
                  </div>
                </li>
                <li class="item-content item-link">
                  <div class="item-inner">
                    <div class="item-title">是否已婚：</div>
                    <div class="item-input">
                      <input type="text" name="marriageSelector" placeholder="请选择">
                      <input type="hidden" name="marriage">
                    </div>
                  </div>
                </li>
              </ul>
            </div>
            
            <div class="list-block has-border">
              
              <p>个人疾病史(如有以下疾病运动损伤史或其他，请一定备注说明）</p>
              
              <div class="input-group">
                <div>
                  <input type="checkbox" name="diseaseDescription" value="患有心脏病">
                  是否患有心脏病
                </div>
                <div>
                  <input type="checkbox" name="diseaseDescription" value="患有骨质疏松症">
                  是否患有骨质疏松症
                </div>
                <div>
                  <input type="checkbox" name="diseaseDescription" value="有血糖及血压疾病">
                  是否有血糖及血压疾病。
                </div>
                <div>
                  <input type="checkbox" name="diseaseDescription" value="有严重的慢性并发症，如心脏，肾，视网膜病变，严重下肢血管病变，植物神经功能障碍等">
                  是否有严重的慢性并发症，如心脏，肾，视网膜病变，严重下肢血管病变，植物神经功能障碍等。
                </div>
                <div>
                  <input type="checkbox" name="diseaseDescription" value="手术完仍处于康复期的患者，比如韧带撕裂康复、骨折康复、半月板损伤康复等">
                  是否手术完仍处于康复期的患者，比如韧带撕裂康复、骨折康复、半月板损伤康复等
                </div>
                <div>
                  <input type="checkbox" name="diseaseDescription" value="有脊椎及关节变形或损伤、肢体重要骨骼有过骨折史">
                  是否有脊椎及关节变形或损伤、肢体重要骨骼有过骨折史。
                </div>
                <div>
                  <input type="checkbox" name="diseaseDescription" value="怀孕或者还处在哺乳期">
                  是否有怀孕或者还处在哺乳期。
                </div>
                <div>
                  <input type="checkbox" name="diseaseDescription" value="存在其他已知或未知的不适应大强度运动的疾病">
                  是否存在其他已知或未知的不适应大强度运动的疾病
                </div>
              </div>
              
            </div>
            
            <div class="list-block has-border">
              
              <p>您决定参加训练营的主要因素是什么?</p>
              
              <div class="input-group">
                <div>
                  <input type="radio" name="source" value="人马君微博">
                  一直有关注人马君微博，觉得内容很可信很靠谱
                </div>
                <div>
                  <input type="radio" name="source" value="人马君微博学员心得">
                  一直有关注人马君微博学员心得，很心动
                </div>
                <div>
                  <input type="radio" name="source" value="微信朋友圈训练饮食打卡">
                  微信朋友圈训练饮食打卡，效果晒图，很心动
                </div>
                <div>
                  <input type="radio" name="source" value="朋友家人">
                  朋友家人参加后效果很好，很心动
                </div>
              </div>
              
            </div>
            
            <div class="list-block has-border" style="margin: 0px;">
              <p>您希望参加人马君后达到怎么样的效果？</p>
              <div class="input-group">
                <textarea rows="3" name="expectations"></textarea>
              </div>
            </div>
            
            
            <div class="content-block" style="margin: 0; padding: 1.75rem .75rem; background-color: #F4F4F4;">
              <a href="javascript:void(0);" style="width: 100%; background-color: #FDDD32; color: #000;" class="button button-big button-success button-fill button-submit">确认提交</a>
            </div>
            
          </form>
          
        </div>
        
      </div>
    </div>
    
    <%@ include file="/WEB-INF/include/script.jsp"%>
    <script type="text/javascript">
      var jsConfig = JSON.parse('${wechatJsConfig}')
      require(['page/trading/online-order-complete'], function(page) {
        page.init({jsConfig: jsConfig})
      })
    </script>
  </body>
</html>